The hidden story behind lower life expectancy

For more than a century, life expectancy steadily increased in the United States. We gained nearly a full decade of life from 1955, when the life expectancy was 69.6 years, to 2014, when it grew to 78.9 years.

Sadly, that trend seems to have reversed itself.

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Our children may not live as long as we do.

In fact, their lives may end prematurely, and by their own choice.

According to the Centers for Disease Control and Prevention (CDC), drug overdoses have had the greatest impact on the changes in life expectancy, particularly for middle-aged white non-Hispanic men and women.

But drug overdoses, mostly involving opioids, may be only a symptom of a more deeply seated social disease.

To understand the pathogenesis of this disease, we need to ask two related questions. First, re drug overdoses actually the main cause of the lower life expectancy? Second, what is driving the demand for drugs of potential abuse that contribute to overdoses?

Last year, Princeton professors Anne Case and Angus Deaton published their findings that cumulative health and personal problems often lead to addictions, overdoses, and suicides that they call "deaths of despair."

While the opioid crisis seems to be an obvious scapegoat, it may not be the major cause of a lower life expectancy. The hidden story is that increased suicides may be as much of a factor as opioids, and that the social factors that lead to suicides and drug overdoses are the real culprits.

Here is why that is probable.

U.S. suicide rates have reached a 30-year high. In fact, the CDC reports more deaths in 2016 from suicides (44,965) than opioids (42,249).

Additionally, overdose deaths and suicides are linked in that an unknown number of the deaths determined to be opioid overdoses may actually be unreported suicides.

The reported drug suicide rate in the United States rose 32 percent between 2000 and 2015.

By contrast, the reported unintentional death rate due to opioids and other drug intoxication increased by 257 percent during the same time period.

A manuscript published in the recent issue of PLOS ONEes by Ian Rockett supports the determination that a vast number of drug overdoses are actually undocumented suicides. The researchers report that this is because psychological evidence, in the form of a suicide note, and psychiatric history, such as documentation of a previous suicide attempt and a diagnosis of depression, are often lacking.

A critical and scholarly commentary published online on December 21 in the American Journal of Public Health challenges the conventional narrative that the overdose crisis' root cause is primarily from overprescribing. The authors assert that the demand for opioids itself is a strong indicator of Americans' demand for pain relief, both physical and emotional.

Despair, depression, hopelessness, and socio-economic factors have fueled spikes in problematic substance use which most visibly manifests as opioid overdose

As Clinical Pain Advisor recently reported, chronic pain patients are more than twice as likely as the general population to end their lives by choice. The article cites a survey of 1,512 people with chronic pain, 32 percent of whom reported they had thoughts of killing themselves. With millions of Americans living with severe pain, there must be a frightening number of people on the precipice of life.

It is difficult to know the scope of suicides among drug overdoses, and which ages or community sectors are most affected. Understanding the extent of the problem will require improvements in the data collection methods as well as the clinical screening efforts.

It also will call upon us to better understand the complex factors driving drug abuse. As importantly, it will require us to realize that suicides and overdoses have common drivers.

Public health efforts must acknowledge, and set as a priority, providing access for mental health services and providing suicide prevention initiatives for both of these populations.

Changes in life expectancy may be a barometer of how well we manage our social and economic problems. If we address the determinants that lead to a self-medicating society and change how we treat those among us who are most hurting — emotionally and physically — we may indeed forge a path to reduce unintentional overdose deaths and suicides as we increase life expectancy.

Lynn R. Webster, MD is Vice President Scientific Affairs for PRA Health Sciences. He is a past President of the American Academy of Pain Medicine. In addition, he is the author of the award-winning book, “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” You can find him on Twitter: @LynnRWebsterMD.